【摘要】：目的探討常規(guī)容量控制(VC)通氣和壓力調(diào)整容量控制(PRVC)通氣對腹腔間隔室綜合征(ACS)患者通氣效果的影響。方法選取2011年5月—2014年5月江蘇大學附屬醫(yī)院ICU收治的ACS患者36例,均行機械通氣治療,采用隨機數(shù)字表法分為兩組:A組19例采用同步間歇指令-容量控制(SIMV-VC)模式,B組17例采用同步間歇指令-壓力調(diào)整容量控制(SIMV-PRVC)模式,采集兩組患者第1天、第3天及第5天血氣分析指標、呼吸力學指標、血流動力學指標及序貫器官衰竭估計評分(SOFA評分)。結(jié)果 A組與B組患者不同時間動脈血氧分壓(Pa O2)、氧合指數(shù)(Pa O2/Fi O2)、吸氣峰壓(PIP)、肺靜態(tài)順應(yīng)性(Cst)比較,存在交互作用(P0.05);A組與B組患者不同時間動脈血二氧化碳分壓(Pa CO2)、肺泡-動脈氧分壓差(A-a DO2)、氣道平均壓(Pmean)、氣道阻力(R)、心率(HR)、平均動脈壓(MAP)、中心靜脈壓(CVP)、SOFA評分比較,不存在交互作用(P0.05);組間Pa O2、Pa CO2、A-a DO2、Pa O2/Fi O2、Pmean、Cst、R、CVP、SOFA評分比較,差異有統(tǒng)計學意義(P0.05);組間PIP、HR、MAP比較,差異無統(tǒng)計學意義(P0.05);不同時間間Pa O2、Pa CO2、A-a DO2、Pa O2/Fi O2、PIP、Pmean、Cst、R、MAP、CVP、SOFA評分比較,差異有統(tǒng)計學意義(P0.05);不同時間間HR比較,差異無統(tǒng)計學意義(P0.05)。結(jié)論 SIMV-PRVC模式機械通氣治療ACS患者,可明顯改善Pa O2、Pa CO2、A-a DO2、Pa O2/Fi O2、Pmean、Cst、R、CVP、SOFA評分,符合肺保護性通氣策略的要求。
[Abstract]:Objective to investigate the effect of routine volume controlled (VC) ventilation and pressure adjusted volume controlled (PRVC) ventilation on the ventilation effect in patients with abdominal compartment syndrome (ACS). Methods from May 2011 to May 2014, 36 patients with ACS were treated with mechanical ventilation in ICU, affiliated Hospital of Jiangsu University. The method of random digital table was used to divide the patients into two groups: group A (19 cases) received synchronous intermittent instruction-volume control (SIMV-VC) mode, group B (17 cases) adopted synchronous intermittent instruction-pressure adjusted volume control (SIMV-PRVC) mode, two groups of patients were collected on the first day. On the 3rd and 5th day, the indexes of blood gas analysis, respiratory mechanics, hemodynamics and SOFA score were evaluated. Results the arterial oxygen partial pressure (Pa O 2), oxygenation index (Pa O2/Fi O 2), inspiratory peak pressure (PIP),) and pulmonary static compliance (Cst) in group A and group B were compared at different times (P0.05). Arterial blood carbon dioxide partial pressure (Pa CO2), alveolar to arterial partial pressure of oxygen (A-a DO2), mean airway pressure (Pmean),) (Pmean), airway resistance (R), heart rate (HR), mean arterial pressure (MAP),) in group A and group B at different times There was no interaction in (CVP), SOFA score of central venous pressure (P0.05). There was significant difference in the scores of Pa O 2 Pa CO2,A-a DO2,Pa O2/Fi O 2 P mean PIP,HR,MAP between the two groups (P0.05), but there was no significant difference in PIP,HR,MAP between the two groups (P0.05). There was significant difference in Pa O 2 Pa CO2,A-a DO2,Pa O2/Fi O 2 P PIP mean CSTP map CVPSOFA score between different time groups (P0.05), but there was no significant difference in HR comparison between different time groups (P0.05). Conclusion SIMV-PRVC mechanical ventilation can obviously improve the score of Pa O _ 2 Pa CO2,A-a DO2,Pa O2/Fi O _ 2 P _ (2 +) CO2,A-a DO2,Pa O2/Fi C _ (2) P _ (SOFA), which meets the requirements of lung protective ventilation strategy.
【作者單位】： 江蘇大學附屬醫(yī)院ICU;
【基金】：鎮(zhèn)江市科技支撐計劃(社會發(fā)展)資助項目(SH2013037)
【分類號】：R459.7

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